Resistance isn’t useless, but antibiotic reform required

In November, I attended the 20th Asia Pacific Congress of Clinical Microbiology and Infection (APCCMI) in Bangkok, drawn by its focus on multidrug-resistant organisms. From lectures and discussions with colleagues from Singapore, Hong Kong, mainland China, Taiwan and Thailand, it was clear these regions face a major and escalating problem with highly resistant pathogens.

Coliforms such as E. coli, common causes of urinary and abdominal infections, are now resistant to all but one or two last-resort antibiotics in around half of serious infections. Treatment options exist, but are prohibitively expensive.

Traditionally, we have looked to the United States and Europe for guidance in infectious-disease management. Yet, sitting among experts from across Southeast Asia – clinicians who deal with these infections daily, and routinely use drugs that I have prescribed only once or twice – it was clear we should now be learning from them. It marks a remarkable shift: we once looked down on their health systems; now we look up to them for leadership.

Antibiotic resistance is spreading globally. Australia remains largely protected by geography and strong infection-control programs, but incursions are inevitable. I’m proud of the infection-control frameworks we’ve developed across Western Australian hospitals, but even the best systems can only delay – not prevent – the inevitable. Within a decade, our resistance rates may resemble those of our neighbours.

Singapore and Japan provide a preview. Both have advanced health systems, yet face substantial resistance burdens. In Singapore, about one-third of Gram-negative blood culture isolates produce Extended-Spectrum Beta-Lactamases (ESBLs), making them resistant to standard antibiotics. In Hong Kong, almost half of Gram-negative bloodstream isolates show the same trait. It’s only a matter of time before we reach similar levels.